Pain Management in Geriatric Population I chose this topic due to a few current issues that face the current population which is the opioid epidemic which has come from over prescription of pain medications and the new research being done on pain science. I wanted to try to see how both of these factors impact the geriatric population.
Objectives:
The objectives of this page are to:
1. Learn more about current pain management issue in geriatrics
2. Learn about the management of chronic pain in older adults
3. Learn about the evidence for exercise and pain management in older adults
4. Summarize the information and recommendations from the research presented
Information about pain management
The Current pain management issue
Just to reiterate the importance of this topic to the geriatric population, a review done in 2010 by Kaye et.al.1 noted that, “The prevalence of persistent pain increases with age; increases in joint pain and neuralgias are particularly common.” Another study by Chai et.al.2 notes that, “Pain is a frequent and often poorly managed symptom in older adults, in part due to the challenges of physiological and cognitive changes common among older adults.” Another example of the prevalence of this is noted in a study by Lazkani et.al3. looked at the financial aspect of pain management and concluded, “The socioeconomic costs of CP (chronic pain) are well established for the general population.” In a recent study con- ducted in the USA, Gaskin et al.4 found that the total costs associated with CP ranged from $560 to $635 billion in 2010.” These stats are all referenced in the article, but with the geriatric population becoming the most rapidly growing in our society (Kaye et al1), there will be an increased need for clinicians to become aware with multiple techniques to manage chronic geriatric pain.
Management of Chronic pain in Geriatrics
While we are in the Physical therapy profession, we must also remember that pain management is done via a holistic approach and there is evidence out there that supports the use of opioids in the geriatric population. A review by van Ojik et. al.5 concluded that, “The opioids of first choice are buprenorphine, fentanyl, hydromorphone, morphine and oxycodone. In patients with renal impairment, a dose reduction may be necessary for morphine becauseof a potential risk of accumulation.” I included this study because we must be aware of the drugs that are currently being prescribed to the geriatric population and how that can affect our treatments as physical therapists. The side effects of those drugs include respiratory depression, accumulation in patients with renal failure, and opioid induced constipation. These opioid treatments will continue to be used during the duration of our professional careers, but I am a firm believer that physical therapists can make a positive impact on this population and maybe show them a new way to cope and deal with pain. We know that exercise is a good and efficient alternative to opioid treatment of chronic pain with “side effects” that include, increased function, better health, and more independence.
Evidence for Use of Exercise in treatment of Chronic Pain
A study by Yadav and Attrey6 they examined 30 patients with pain due to knee OA and treated them with either dynamic or isometric resistance exercises and observed the effect. Their study concluded that, "Dynamic resistance exercise training is proved to be more effective than isometric resistance training in improving functional ability that require wide range of motion.” This is clinically important because dynamic resistance training can be done with a variety ofways with body weight, resistance bands, and free weights. Chai et. al.2 suggests that exercise should be considered with every geriatric patient that has chronic pain. Chai noted that, “Patients with severe physical impairments still can benefit from physical activities focused on improving range of motion and muscle strength to decrease the pain.” With this information, we must continue to make an effort to get people moving and keep people moving. Fitzharles et. al.7 noted that individualized exercise programs, weight management, and practitioner-administered treatments (manual therapy, TENS) can be effective in the reduction of pain in geriatric OA patients.
Summary
In conclusion, physical therapists must understand the pain epidemic that is growing in the geriatric population. We as therapists must understand the medications that are currently being used and how they will affect any given physical therapy session. We must know and properly advocate that movement of any sort (passive or active) can be effective in the treatment of chronic pain. We should implement the use of dynamic strengthening over isometrics when treating pain. Lastly, we should recommend weight reduction and an individualized exercise program to be effective in the management of chronic pain in the geriatric population.
References
1. Alan D. Kaye, Amir Baluch, and Jared T. Scott (2010) Pain Management in the Elderly Population: A Review. The Ochsner Journal: Fall 2010, Vol. 10, No. 3, pp. 179-187.
2.Chai E, Horton J. Managing pain in the elderly population: pearls and pitfalls. Current Pain & headache Reports (serial online). December 2010;14(6):409-417. Available from: CINAHL Complete, Ipswich, MA. Accessed May 23, 2017
3. Lazkani A, Delespierre T, Becguemont L, et. al. Healthcare costs associated with elderly chronic pain patients in primary care. European Journal of Clinical Pharmacology (serial online). August 2015; 71(8): 939-947. Available from CINAHL complete, Ipswich MA. Accessed May 23, 2017
4. Gaskin DJ, Richard P (2012) The economic costs of pain in the United States. J Pain 13(8):715–724
5. Van Ojikk A, Jansen P, Brouwere K, van Boon E. Treatment of Chronic pain in Older People: Evidence Based Choice of Strong-Acting Opioids, Drugs & Aging (serial online). August 2012;29(8) 615-625. Available from: CINAHL. Complete Ipswich, MA. Accessed May 23, 2017
6. Yadav M, Attrey P. Effects of dynamic Versus Isometric Resistance Exercise on Pain and functional ability in Elderly Patients with Osteoarthritis of Knee. India Journal of Physiotherapy & Occupational Therapy (serial online) April 2017; 11(2) 30-34. Avaliable from CINAHL. Complete Ipswich, MA. Accessed May 23,2017.
7. Fitzharles, M., Lussier, D., & Shir, Y. (2010). Management of chronic arthritis pain in the elderly. Drugs & Aging, 27(6), 471-490. doi:10.2165/11536530-000000000-00000 Avaliable from CINAHL. Complete Ipswich, MA. Accessed July 3,2017.
I chose this topic due to a few current issues that face the current population which is the opioid epidemic which has come from over prescription of pain medications and the new research being done on pain science. I wanted to try to see how both of these factors impact the geriatric population.
Objectives:
The objectives of this page are to:
Information about pain management
The Current pain management issue
Just to reiterate the importance of this topic to the geriatric population, a review done in 2010 by Kaye et.al.1 noted that, “The prevalence of persistent pain increases with age; increases in joint pain and neuralgias are particularly common.” Another study by Chai et.al.2 notes that, “Pain is a frequent and often poorly managed symptom in older adults, in part due to the challenges of physiological and cognitive changes common among older adults.” Another example of the prevalence of this is noted in a study by Lazkani et.al3. looked at the financial aspect of pain management and concluded, “The socioeconomic costs of CP (chronic pain) are well established for the general population.” In a recent study con- ducted in the USA, Gaskin et al.4 found that the total costs associated with CP ranged from $560 to $635 billion in 2010.” These stats are all referenced in the article, but with the geriatric population becoming the most rapidly growing in our society (Kaye et al1), there will be an increased need for clinicians to become aware with multiple techniques to manage chronic geriatric pain.
Management of Chronic pain in Geriatrics
While we are in the Physical therapy profession, we must also remember that pain management is done via a holistic approach and there is evidence out there that supports the use of opioids in the geriatric population. A review by van Ojik et. al.5 concluded that, “The opioids of first choice are buprenorphine, fentanyl, hydromorphone, morphine and oxycodone. In patients with renal impairment, a dose reduction may be necessary for morphine becauseof a potential risk of accumulation.” I included this study because we must be aware of the drugs that are currently being prescribed to the geriatric population and how that can affect our treatments as physical therapists. The side effects of those drugs include respiratory depression, accumulation in patients with renal failure, and opioid induced constipation. These opioid treatments will continue to be used during the duration of our professional careers, but I am a firm believer that physical therapists can make a positive impact on this population and maybe show them a new way to cope and deal with pain. We know that exercise is a good and efficient alternative to opioid treatment of chronic pain with “side effects” that include, increased function, better health, and more independence.
Evidence for Use of Exercise in treatment of Chronic Pain
A study by Yadav and Attrey6 they examined 30 patients with pain due to knee OA and treated them with either dynamic or isometric resistance exercises and observed the effect. Their study concluded that, "Dynamic resistance exercise training is proved to be more effective than isometric resistance training in improving functional ability that require wide range of motion.” This is clinically important because dynamic resistance training can be done with a variety ofways with body weight, resistance bands, and free weights. Chai et. al.2 suggests that exercise should be considered with every geriatric patient that has chronic pain. Chai noted that, “Patients with severe physical impairments still can benefit from physical activities focused on improving range of motion and muscle strength to decrease the pain.” With this information, we must continue to make an effort to get people moving and keep people moving. Fitzharles et. al.7 noted that individualized exercise programs, weight management, and practitioner-administered treatments (manual therapy, TENS) can be effective in the reduction of pain in geriatric OA patients.
Summary
In conclusion, physical therapists must understand the pain epidemic that is growing in the geriatric population. We as therapists must understand the medications that are currently being used and how they will affect any given physical therapy session. We must know and properly advocate that movement of any sort (passive or active) can be effective in the treatment of chronic pain. We should implement the use of dynamic strengthening over isometrics when treating pain. Lastly, we should recommend weight reduction and an individualized exercise program to be effective in the management of chronic pain in the geriatric population.
References